High barriers to treatment are associated with stereotactic radiation instead of surgery for patients with operable stage I non-small cell lung cancer.

Abstract

Although surgery is considered the standard of care for early-stage lung cancer, there has been increased use of stereotactic radiotherapy for operable patients in recent years. Given that this modality may be perceived as a more practical treatment, we hypothesized that it might be more often delivered to patients who experience barriers to care. The National Cancer Database(2018-2020) was queried for patients with clinical stage IA non-small cell lung cancer treated with surgery or stereotactic radiotherapy(48-60Gy,3-5 fractions), excluding patients with contraindications to surgery. Patients who had all the following characteristics were categorized as experiencing "high barriers" to treatment: income below median national levels, lack of private insurance, treatment at a community facility and residence in non-metropolitan areas. Using multivariable logistic regression, the association between high barriers to treatment and stereotactic radiotherapy use was estimated. A total of 60,829 patients were included, of whom 3,382(5.6%) experienced high barriers to treatment. Among them, 13,535(22.3%) underwent stereotactic radiotherapy and 47,294(77.7%) surgery. Overall, more patients undergoing stereotactic radiotherapy faced high barriers to treatment compared to those who received surgery (8.6%vs.4.7%,p<0.001). Geographic region was associated with the delivery of stereotactic radiotherapy (p < 0.001). The magnitude of such association was stronger among those who faced high barriers. In multivariable analysis, experiencing high barriers to treatment remained associated with receiving stereotactic radiotherapy (OR:1.46,95%CI 1.35-1.58). The use of stereotactic radiotherapy is more prevalent among patients facing barriers to care. Further research is needed to clarify the role of this treatment modality in early-stage lung cancer.